In November 2008, more than 57 percent of Washington voters approved the Death with Dignity Act. Washington became the third state, following Oregon and Montana, to allow a licensed physician to prescribe life-ending medication upon request of a competent, terminally ill patient.
The Washington and Oregon laws require a physician to follow and document a process designed to insure that the patient is well-informed about possible treatment and pain-control options and is acting voluntarily and deliberately. The act requires, among other things, a second physician’s examination that confirms death from the underlying disease is likely within six months and the competence of the patient to choose, as well as impartial witnesses and a waiting period before the medication can be dispensed.
The Washington Department of Health reports that in 2010, the first full year the act was in effect, 87 people participated in the program, of which 72 persons died: of those, 51 died from the lethal medication, 15 from other causes, one of unknown cause and five reports were pending. Men and women participated about equally. Eighty-four percent were enrolled in hospice care, and the waiting period before dispensing the medication ranged from three to 54 weeks. The reasons for participation most commonly cited were loss of autonomy and inability to engage in activities making life enjoyable. The reason least cited was the cost of treatment.
It appears so far that the Death with Dignity Act is living up to its title.
To improve the chances of passage, the Death with Dignity Act was written to apply only to the choices of the terminally ill who are competent at the time of their death.
This raises the question whether, if the act continues to work as intended, we should extend the choice of voluntary euthanasia to:
• Persons who are not terminally ill but suffering a severely debilitating medical condition they judge to be unbearable.
• Persons who are not competent at the time of their death but who previously made a competent choice of euthanasia as evidenced through a special type of advance directive.
Some will reject any extension of euthanasia on the grounds that all human life is precious and should in all circumstances be preserved. Yet our society places a great value on individual liberty. Those opposed to euthanasia are free to choose to endure great suffering at their life’s end. But why should they be entitled to force others to do so?
Opponents to euthanasia answer this question by arguing that any expansion of euthanasia would result in vulnerable, disabled and poor individuals being manipulated or pressured by others to choose early death or otherwise choosing early death without making an enduring, informed, and voluntary choice.
However, it seems plausible that the potential for abuse of the vulnerable can be adequately addressed with safeguards that are carefully designed to ensure that a choice for euthanasia based on suffering or advance directives is actually enduring, informed and voluntary.
For example, where great medical suffering would serve as the basis for physician-assisted euthanasia, the law may require a longer waiting period such as six months and an additional level of review by a judge and possibly a psychologist. Similarly, the legal requirements for an advance directive on euthanasia might require use of forms with detailed medical directions, written reports of a physician and a psychologist verifying competence and informed choice, a videotaped interview, and a reaffirmation of the directive after a six-month minimum waiting period.
Opponents also argue that even a carefully safeguarded expansion of voluntary euthanasia will erode the value that society places on human life and thereby open the door to involuntary euthanasia. But where is the proof for this claim? This brief discussion most certainly does not do justice to the many thoughtful perspectives on voluntary euthanasia, but it strikes me that a key question for this debate is this: does the chance that some abuse of voluntary euthanasia might occur despite the safeguards outweigh both the liberty to make up ones own mind whether to continue a life of suffering and the suffering that would have been avoided if that liberty were not denied?
Brian Faller, a local attorney, is a member of The Olympian’s Board of Contributors. He can be reached at email@example.com.